ATLS Practice Exam With Complete Questions And Answers
Graded A+
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults. Correct Answer: True
In the elderly population, what is decreased physiological reserve? Correct Answer: aging is
characterized by impaired adaptive and homeostatic mechanisms that caused an increased
susceptibility to the stress of injury. Insults tolerated by the younger population can lead to
devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: Correct Answer: cirrhosis,
coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? Correct Answer: Fall. Nonfatal falls are
common in women and fractures are common in women who fall. Falls are the most common cause
of TBI.
In the elderly population, what are risk factors for falls? Correct Answer: advanced age, physical
impairment, history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive
impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why? Correct Answer: Older people drive on more familiar roads and at lower speeds and
tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited
cervical mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high
Correct Answer: True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate
number of hair follicles, will result in a full thickness burn in older patients. Correct Answer: this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what? Correct Answer: bag mask ventilation, as it
improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives
should be reduced to what percentage to minimize the risk of cardiovascular depression? Correct
Answer: 20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta
blockers) Correct Answer: this results in lack of classic response to hypovolemia, risk for cardiac
ischemia, elevated BP at baseline, and increased risk of dysrythmias.
,Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex Correct Answer: thus they are at increased risk
for respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased
sensitivity to ADH and aldosterone Correct Answer: resulting in drug dosing for renal insufficiency,
decreased ability to concentrate urine, increased risk for AKI and urine flow may be normal with
hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and
cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat Correct
Answer: resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk
of skin injury, increased risk for hypothermia, challenges in rehabiliation
Functional changes in Endocrine system include decreased production and response to thyroxin and
decreased dehydroepiandrosterone (DHEA) Correct Answer: resulting in occult hypothyroidism,
relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel
degenerative changes affecting disk spaces and posterior elements associated with severe central
canal stenosis, cord compression, and myelomalacia Correct Answer: true
In elderly population, due to their changes in pulmonary system, placing a gauze between gums and
cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because aging
causes a suppressed heart rate response to hypoxia...... Correct Answer: respiratory failure may
present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at significant risk
for being inaccurately categorized as hemodynamically stable. Correct Answer: Elderly patients have
a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing
their systemic vascular resistance. Furthermore, since older patients have HTN, an acceptable BP
may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for
identifying hypotension in patients 65 and older.
Do no equate blood pressure with shock in older patients Correct Answer: BP in older patients may
look normal due to the medications they are on. Use lactate and base deficit to evaluate for evidence
of shock
what 2 factors place elderly patients at risk for intracranial hemorrhage? Correct Answer: aging
causes dura to become more adherent to the skull increasing risk of injury and older patients are on
anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility. Correct Answer: Rapid evaluation and when
possible early liberation from spine boards and cervical collars will minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures. Correct Answer: true
, poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......? Correct Answer: Elder maltreatment. The presence of physical
findings of maltreatment should prompt a detailed history. if history conflicts with findings,
immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation Correct Answer: True. A simple injury such as an open tibia
fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries Correct Answer:
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False?
Correct Answer: True. Also if xray examination is indicated during the pregnant patient's treatment, it
should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad. Correct Answer: When the
uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a result,
the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its contents
(fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at
20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False Correct Answer: True
By the third trimester, what is the complication of trauma to the pelvis of the mother? Correct Answer:
by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually
in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late
gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
Correct Answer: this is true
Physiological anemia of pregnancy Correct Answer: A smaller increase in red blood cell volume can
occur resulting in a decreased hematocrit level. Thus, in late pregnancy a hematocrit of 31-33% is
normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting signs and symptoms of
hypovolemia. How can this manifest? Correct Answer: this amount of hemorrhage may be reflected
by fetal distress as evidenced by an abnormal fetal heart rate.
What are some of the lab changes in pregnancy? Correct Answer: WBC increases to 12000 and
during labor can be 25000. Fibrinogen and other clotting factors are mildly elevated and PT and pTT
are shortened, but bleeding time and clotting time are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase
in plasma volume and decrease in vascular resistance of the uterus and placenta. Correct Answer:
Graded A+
True or false? Although the mechanism of injury may be similar to those for the younger population,
data shows increased mortality with similar severity of injury in older adults. Correct Answer: True
In the elderly population, what is decreased physiological reserve? Correct Answer: aging is
characterized by impaired adaptive and homeostatic mechanisms that caused an increased
susceptibility to the stress of injury. Insults tolerated by the younger population can lead to
devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: Correct Answer: cirrhosis,
coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? Correct Answer: Fall. Nonfatal falls are
common in women and fractures are common in women who fall. Falls are the most common cause
of TBI.
In the elderly population, what are risk factors for falls? Correct Answer: advanced age, physical
impairment, history of previous fall, medication use, dementia, unsteady gait, and visual, cognitive
impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why? Correct Answer: Older people drive on more familiar roads and at lower speeds and
tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited
cervical mobility, decreased hearing, and cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high
Correct Answer: True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate
number of hair follicles, will result in a full thickness burn in older patients. Correct Answer: this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what? Correct Answer: bag mask ventilation, as it
improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives
should be reduced to what percentage to minimize the risk of cardiovascular depression? Correct
Answer: 20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta
blockers) Correct Answer: this results in lack of classic response to hypovolemia, risk for cardiac
ischemia, elevated BP at baseline, and increased risk of dysrythmias.
,Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex Correct Answer: thus they are at increased risk
for respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased
sensitivity to ADH and aldosterone Correct Answer: resulting in drug dosing for renal insufficiency,
decreased ability to concentrate urine, increased risk for AKI and urine flow may be normal with
hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and
cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat Correct
Answer: resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk
of skin injury, increased risk for hypothermia, challenges in rehabiliation
Functional changes in Endocrine system include decreased production and response to thyroxin and
decreased dehydroepiandrosterone (DHEA) Correct Answer: resulting in occult hypothyroidism,
relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have multilevel
degenerative changes affecting disk spaces and posterior elements associated with severe central
canal stenosis, cord compression, and myelomalacia Correct Answer: true
In elderly population, due to their changes in pulmonary system, placing a gauze between gums and
cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because aging
causes a suppressed heart rate response to hypoxia...... Correct Answer: respiratory failure may
present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at significant risk
for being inaccurately categorized as hemodynamically stable. Correct Answer: Elderly patients have
a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing
their systemic vascular resistance. Furthermore, since older patients have HTN, an acceptable BP
may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for
identifying hypotension in patients 65 and older.
Do no equate blood pressure with shock in older patients Correct Answer: BP in older patients may
look normal due to the medications they are on. Use lactate and base deficit to evaluate for evidence
of shock
what 2 factors place elderly patients at risk for intracranial hemorrhage? Correct Answer: aging
causes dura to become more adherent to the skull increasing risk of injury and older patients are on
anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility. Correct Answer: Rapid evaluation and when
possible early liberation from spine boards and cervical collars will minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures. Correct Answer: true
, poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......? Correct Answer: Elder maltreatment. The presence of physical
findings of maltreatment should prompt a detailed history. if history conflicts with findings,
immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation Correct Answer: True. A simple injury such as an open tibia
fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries Correct Answer:
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or False?
Correct Answer: True. Also if xray examination is indicated during the pregnant patient's treatment, it
should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad. Correct Answer: When the
uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a result,
the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its contents
(fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and then at
20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False Correct Answer: True
By the third trimester, what is the complication of trauma to the pelvis of the mother? Correct Answer:
by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually
in the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late
gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
Correct Answer: this is true
Physiological anemia of pregnancy Correct Answer: A smaller increase in red blood cell volume can
occur resulting in a decreased hematocrit level. Thus, in late pregnancy a hematocrit of 31-33% is
normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting signs and symptoms of
hypovolemia. How can this manifest? Correct Answer: this amount of hemorrhage may be reflected
by fetal distress as evidenced by an abnormal fetal heart rate.
What are some of the lab changes in pregnancy? Correct Answer: WBC increases to 12000 and
during labor can be 25000. Fibrinogen and other clotting factors are mildly elevated and PT and pTT
are shortened, but bleeding time and clotting time are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase
in plasma volume and decrease in vascular resistance of the uterus and placenta. Correct Answer:
